Intraluminal ultrasound imaging with automatic and assisted labels and bookmarks

ABSTRACT

Disclosed is an intraluminal ultrasound imaging system, including a processor circuit in communication with an intraluminal ultrasound imaging catheter, and configured to receive a plurality of intraluminal ultrasound images from the imaging catheter during movement of the imaging catheter within a body lumen of a patient, the body lumen comprising a plurality of segments. The processor circuit is further configured to generate a marker to be applied to an intraluminal ultrasound image of the plurality of intraluminal ultrasound images, wherein the marker is generated based on the movement of the intraluminal ultrasound imaging catheter, and wherein the marker is representative of a segment of the plurality of segments, and output to a display the marker and the plurality of intraluminal ultrasound images shown successively.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority to and the benefit of U.S. ProvisionalPatent Application No. 62/751,268, filed Oct. 26, 2018, which isincorporated by reference herein in its entirety.

TECHNICAL FIELD

The subject matter described herein relates to a system for medicalimaging. In particular, the disclosed system provides a system forbookmarking and labeling peripheral intravascular ultrasound or IVUSimages during a pullback procedure. This system has particular but notexclusive utility for diagnosis and treatment of vascular diseases.

BACKGROUND

Peripheral vascular procedures, such as angioplasty and stenting inperipheral venous (Inferior Vena Cava—IVC, iliac, femoral veins),IVC-filter retrieval, EVAR and FEVAR (and similar on the abdominaltrait) atherectomy and thrombectomy are procedures where IVUS is used.Different diseases or medical procedures produce physical features withdifferent size, structure, density, water content, and accessibility forimaging sensors. For example, a deep-vein thrombosis (DVT) produces aclot of blood cells, whereas post-thrombotic syndrome (PTS) produceswebbing or other residual structural effects in a vessel that havesimilar composition to the vessel wall itself, and may thus be difficultto distinguish from the vessel wall. A stent is a dense (e.g., metallic)object that may be placed in a vessel or lumen to hold the vessel orlumen open to a particular diameter. A compression occurs whenanatomical structures outside the vessel or lumen impinge on the vesselor lumen, constricting it.

In some cases, intraluminal medical imaging is carried out with an IVUSdevice including one or more ultrasound transducers. The IVUS device maybe passed into the vessel and guided to the area to be imaged. Thetransducers emit ultrasonic energy and receive ultrasound echoesreflected from the vessel. The ultrasound echoes are processed to createan image of the vessel of interest. The image of the vessel of interestmay include one or more lesions or blockages in the vessel. A stent maybe placed within the vessel to treat these blockages and intraluminalimaging may be carried out to view the placement of the stent within thevessel. Other types of treatment include thrombectomy, ablation,angioplasty, pharmaceuticals, etc.

Labelling and annotations are often repetitive and time consuming in atypical IVUS workflow. Additionally, while placing bookmarks, the timebetween the physician or other user calling for bookmarks and actualplacement of bookmark can lead to placement of the bookmark on a framenot originally intended by the physician or other user. In these cases,the physician or other user often has to go back and find the rightframe of interest for further investigation, measurement, or analysis.Current methods of bookmarking/labelling often include selection from apick list or editing that involves manual interaction by a user. Often,the saved bookmark includes only generic text that must later becustomized or elaborated by the clinician.

The information included in this Background section of thespecification, including any references cited herein and any descriptionor discussion thereof, is included for technical reference purposes onlyand is not to be regarded as subject matter by which the scope of thedisclosure is to be bound.

SUMMARY

Disclosed is a system for advantageously tagging, labeling, andannotating intraluminal images from an intraluminal medical imagingsequence (e.g., an IVUS pullback sequence) using labels automatically(e.g., predictively) provided by the system, or else selected by a userfrom a short list automatically provided by the system, thus permittingrapid, accurate real-time bookmarking of the location and severity ofdiseases or compressions of the lumen, along with reference images,post-treatment images, and other images. The system is hereinafterreferred to as an automatic and assisted bookmarking system.

Automatically generated or assistive-ly suggested labels/bookmarks forIVUS make the placement of labels/bookmarks simpler and faster than iscurrently possible. By having the user select a procedure type such ascoronary/peripheral, venous or arterial, the system is able to supply alist of relevant bookmarks for the user to select. The user can drag anddrop the labels/bookmarks where appropriate, and can also edit labelsand bookmarks as needed. Labels and bookmarks can be automated,semi-automated or user driven. Bookmarks can also provide a selectablerange of neighboring frames to choose from.

The automatic and assisted bookmarking system disclosed herein hasparticular, but not exclusive, utility for intraluminal ultrasoundimaging procedures. One general aspect includes an intraluminalultrasound imaging system, including: a processor circuit configured forcommunication with an intraluminal ultrasound imaging catheter, wherethe processor circuit is configured to: receive a plurality ofintraluminal ultrasound images obtained by the intraluminal ultrasoundimaging catheter during movement of the intraluminal ultrasound imagingcatheter within a body lumen of a patient, the body lumen including aplurality of segments; generate a marker to be applied to anintraluminal ultrasound image of the plurality of intraluminalultrasound images, where the marker is generated based on the movementof the intraluminal ultrasound imaging catheter, and where the marker ispredictive and/or representative of a segment of the plurality ofsegments; and output, to a display in communication with the processorcircuit, a screen display including the marker and the plurality ofintraluminal ultrasound images. Other embodiments of this aspect includecorresponding computer systems, apparatus, and computer programsrecorded on one or more computer storage devices, each configured toperform the actions of the methods.

Implementations may include one or more of the following features. Thesystem further including a user interface, where the processor circuitis configured to receive a user input, via the user interface, to applythe marker to the intraluminal ultrasound image of the plurality ofintraluminal ultrasound images. The system where, in response to thereceiving the user input to apply the marker, the processor circuit isconfigured to apply with the marker one or more other intraluminalultrasound images neighboring the intraluminal ultrasound image. Thesystem where the display includes a touchscreen, and where the userinterface includes a drag-and-drop interface on the touchscreen, andwhere the user input includes a drag-and-drop input. The system wherethe user interface includes a voice recognition interface, and the userinput includes a spoken confirmation. The system where the processorcircuit is further configured to output stylized diagram of the bodylumen including the plurality of segments, where the marker identifies alocation in the stylized diagram where the segment begins. The systemwhere the processor circuit is configured to: generate a plurality ofmarkers to be applied to the plurality of ultrasound images; and outputthe plurality of markers successively, where each of the plurality ofmarkers corresponds to a different segment of the plurality of segments.The system where the processor circuit is configured to determine anorder for the successive output of the plurality of markers based on themovement of the intraluminal ultrasound imaging catheter. The systemwhere the processor circuit is configured to determine the order basedon at least one of an access point to the body lumen or a direction ofmovement of the intraluminal ultrasound imaging catheter. The systemfurther including the intraluminal ultrasound imaging catheter, wherethe intraluminal ultrasound imaging catheter includes an intravascularultrasound (IVUS) imaging catheter, and where the body lumen includes aperipheral blood vessel. Implementations of the described techniques mayinclude hardware, a method or process, or computer software on acomputer-accessible medium.

One general aspect includes an intraluminal ultrasound imaging system,including: a processor circuit configured for communication with anintraluminal ultrasound imaging catheter, where the processor circuit isconfigured to: receive an intraluminal ultrasound image obtained by theintraluminal ultrasound imaging catheter during movement of theintraluminal ultrasound imaging catheter within a body lumen of apatient; generate a plurality of text labels; output a screen displayincluding a first portion includes the intraluminal ultrasound image anda second portion including the plurality of text labels, where the firstportion is proximate to the second portion; receive a drag-and-drop userinput moving a text label of the plurality of text labels from thesecond portion to the first portion; and associate the text label withthe intraluminal ultrasound image. Other embodiments of this aspectinclude corresponding computer systems, apparatus, and computer programsrecorded on one or more computer storage devices, each configured toperform the actions of the methods.

One general aspect includes an intraluminal ultrasound imaging method,including: receiving, at a processor circuit in communication with anintraluminal ultrasound imaging catheter, a plurality intraluminalultrasound images obtained by the intraluminal ultrasound imagingcatheter during movement of the intraluminal ultrasound imaging catheterwithin a body lumen of a patient, the body lumen including a pluralityof segments; generating a marker to be applied to an intraluminalultrasound image of the plurality intraluminal ultrasound images, wherethe marker is generated based on the movement of the intraluminalultrasound imaging catheter, and where the marker is predictive and/orrepresentative of a segment of the plurality of segments; andoutputting, to a display in communication with the processor circuit, ascreen display including the marker and the plurality of intraluminalultrasound images shown successively. Other embodiments of this aspectinclude corresponding computer systems, apparatus, and computer programsrecorded on one or more computer storage devices, each configured toperform the actions of the methods.

Implementations may include one or more of the following features. Themethod further including receiving a user input, via a user interfaceoperating on the processor circuit, to apply the marker to theintraluminal ultrasound image of the plurality of intraluminalultrasound images. The method further including, in response to thereceiving the user input to apply the marker, applying the marker to oneor more other intraluminal ultrasound images neighboring theintraluminal ultrasound image. The method where the display includes atouchscreen, and where the user interface includes a drag-and-dropinterface on the touchscreen, and where the user input includes adrag-and-drop input. The method where the user interface includes avoice recognition interface, and the user input includes a spokenconfirmation. The method further including outputting a stylized diagramof the body lumen including the plurality of segments, where the markeridentifies a location in the stylized diagram where the segment begins.The method further including: generating a plurality of markers to beapplied to the plurality of ultrasound images; and outputting, to thedisplay in communication with the processor circuit, a screen displayincluding the plurality of markers successively, where each of theplurality of markers corresponds to a different segment of the pluralityof segments. The method further including determining an order for thesuccessive output of the plurality of markers based on the movement ofthe intraluminal ultrasound imaging catheter. The method furtherincluding determining the order based on at least one of an access pointto the body lumen or a direction of movement of the intraluminalultrasound imaging catheter. Implementations of the described techniquesmay include hardware, a method or process, or computer software on acomputer-accessible medium.

This Summary is provided to introduce a selection of concepts in asimplified form that are further described below in the DetailedDescription. This Summary is not intended to identify key features oressential features of the claimed subject matter, nor is it intended tolimit the scope of the claimed subject matter. A more extensivepresentation of features, details, utilities, and advantages of theautomatic and assisted bookmarking system, as defined in the claims, isprovided in the following written description of various embodiments ofthe disclosure and illustrated in the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

Illustrative embodiments of the present disclosure will be describedwith reference to the accompanying drawings, of which:

FIG. 1 is a diagrammatic schematic view of an intraluminal imagingsystem, according to aspects of the present disclosure.

FIG. 2 illustrates blood vessels (e.g., arteries and veins) in the humanbody.

FIG. 3 illustrates a blood vessel incorporating a compression.

FIG. 4 illustrates a blood vessel incorporating a compression and with astent expanded inside it to restore flow.

FIG. 5 illustrates an example intraluminal imaging display screen inaccordance with at least one embodiment of the present disclosure.

FIG. 6 shows a graphical roadmap screen display of an exemplaryautomatic and assisted bookmarking system during a pullback procedure ina left leg vein of a patient, in accordance with at least one embodimentof the present disclosure.

FIG. 7 shows a graphical roadmap screen display of an exemplaryautomatic and assisted bookmarking system during a pullback procedure ina left leg vein of a patient, in accordance with at least one embodimentof the present disclosure.

FIG. 8 is a flow diagram for an intraluminal image bookmarking methodaccording to the related art.

FIG. 9 is a flow diagram for an intraluminal image bookmarking methodaccording to at least one embodiment of the present disclosure.

FIG. 10 is a schematic diagram of a processor circuit, according toembodiments of the present disclosure.

FIG. 11 is a screenshot of an IVUS access point selection screen, inaccordance with at least one embodiment of the present disclosure.

DETAILED DESCRIPTION

The present disclosure relates generally to medical imaging, includingimaging associated with a body lumen of a patient using an intraluminalimaging device. For example, the present disclosure describes systems,devices, and methods for labeling and bookmarking intraluminal imagesduring an intraluminal imaging procedure such as an IVUS pullback. Dragand drop labels and bookmarks are provided to users to enable a simplerand faster way of placing labels and bookmarks. Appropriate labels andbookmarks appear based on user selections including procedure type(coronary/peripheral, venous/arterial, etc.), entry point, entrydirection or pullback direction, and disease type. Labels and bookmarkscontain information such as anatomical references or diseasestates/types. Using confirmation inputs from the user, the system isable to place the labels and bookmarkers where and when appropriate. Thesystem also makes it possible to customize or edit labels and bookmarks.Labels and bookmarks can be saved to the IVUS image, ILD, graphicalrepresentation of anatomy, pre/post images, roadmap images, and reports.On the anatomical map, automated labels would appear in successive orderto allow users to correctly label anatomical segments, as well assegments or sub-segments within the segments (e.g., a lesion/plaquebuildup, an area of compression, healthy tissue used as a reference,etc.). The creation of labels or bookmarks can be automated,semi-automated or user driven, according to aspects of the presentdisclosure.

The automatic and/or assisted bookmarking system provides easy and fastplacement of labels and bookmarks using (for example) drag and dropfunctionality, not only to the IVUS image itself but to an ILD,graphical roadmap or other graphical representation of anatomy, for bothpre- and post-treatment images. In an example, the processor circuit isreceiving an electrical signal representative of the drag and dropinput. Depending on the application, a list of commonly used labels foranatomical locations/disease states is created for coronary/peripheraland venous/arterial procedures, and accessed by the user via drag anddrop functionality. Additionally, a user of the system is able tomanually edit labels and/or bookmarks as desired, if necessary. Thissystem is hereinafter referred to as an automatic and assistedbookmarking system.

The devices, systems, and methods described herein can include one ormore features described in U.S. Provisional App. No. 62/750,983(Attorney Docket No. 2018PF01112-44755.2000PV01), filed 26 Oct. 2018,U.S. Provisional App. No. 62/751,268 (Attorney Docket No.2018PF01160-44755.1997PV01), filed 26 Oct. 2018, U.S. Provisional App.No. 62/751,289 (Attorney Docket No. 2018PF01159-44755.1998PV01), filed26 Oct. 2018, U.S. Provisional App. No. 62/750,996 (Attorney Docket No.2018PF01145-44755.1999PV01), filed 26 Oct. 2018, U.S. Provisional App.No. 62/751,167 (Attorney Docket No. 2018PF01115-44755.2000PV01), filed26 Oct. 2018, and U.S. Provisional App. No. 62/751,185 (Attorney DocketNo. 2018PF01116-44755.2001PV01), filed 26 Oct. 2018, each of which ishereby incorporated by reference in its entirety as though fully setforth herein.

The devices, systems, and methods described herein can also include oneor more features described in U.S. Provisional App. No. 62/642,847(Attorney Docket No. 2017PF02103), filed Mar. 14, 2018 (and aNon-Provisional Application filed therefrom on Mar. 12, 2019 as U.S.Ser. No. 16/351,175), U.S. Provisional App. No. 62/712,009 (AttorneyDocket No. 2017PF02296), filed Jul. 30, 2018, U.S. Provisional App. No.62/711,927 (Attorney Docket No. 2017PF02101), filed Jul. 30, 2018, andU.S. Provisional App. No. 62/643,366 (Attorney Docket No. 2017PF02365),filed Mar. 15, 2018 (and a Non-Provisional Application filed therefromon Mar. 15, 2019 as U.S. Ser. No. 16/354,970), each of which is herebyincorporated by reference in its entirety as though fully set forthherein.

The present disclosure substantially aids a clinician in making sense oflarge volumes of intraluminal imaging data, along with reporting andtreatment planning, plus reduced case time and improved ease of use. Thepresent disclosure accomplishes this by providing a quick, seamlessprocess for identification, marking, and annotation of locations ofinterest within a vessel or lumen along an examined length, in real timeduring the imaging procedure (e.g., an IVUS pullback procedure).Implemented on a medical imaging console (e.g., an IVUS imaging console)in communication with a medical imaging sensor (e.g., an intraluminalultrasound sensor), the automatic and assisted bookmarking systemdisclosed herein provides both time savings and an improvement in theaccuracy of bookmarking and labeling of captured images. This improvedimaging workflow transforms a time-consuming process of imaging, imageselection, data entry, review, and revision into a streamlined processinvolving both fewer steps and simpler steps. This occurs for examplewithout the normally routine need for secondary or non-sterile users totype in bookmark and label data in real time, along with the associatedtime lags. This unconventional approach improves the functioning of themedical imaging console and sensor, by automating bookmarking andlabeling steps that are normally performed manually by the clinician orother users.

The automatic and assisted bookmarking system may be implemented as aset of logical branches and mathematical operations, whose outputs areviewable on a display, and operated by a control process executing on aprocessor that accepts user inputs (e.g., from a user interface such asa keyboard, mouse, or touchscreen interface), and that is incommunication with one or more medical imaging sensors (e.g.,intraluminal ultrasound sensors). In that regard, the control processperforms certain specific operations in response to different inputs orselections made by a user at the start of an imaging procedure, and mayalso respond to inputs made by the user during the procedure. Certainstructures, functions, and operations of the processor, display,sensors, and user input systems are known in the art, while others arerecited herein to enable novel features or aspects of the presentdisclosure with particularity.

Various types of intraluminal imaging systems are used in diagnosing andtreating diseases. For example, intravascular ultrasound (IVUS) imagingis used as a diagnostic tool for visualizing vessels within a body of apatient. This may aid in assessing diseased or compressed vessels, suchas arteries or veins, within the human body to determine the need fortreatment, to optimize treatment, and/or to assess a treatment'seffectiveness (e.g., through imaging of the vessel before and aftertreatment).

In some cases, intraluminal imaging is carried out with an IVUS deviceincluding one or more ultrasound transducers. The IVUS device may bepassed into the vessel and guided to the area to be imaged. Thetransducers emit ultrasonic energy and receive ultrasound echoesreflected from the vessel. The ultrasound echoes are processed to createan image of the vessel of interest. The image of the vessel of interestmay include one or more lesions or blockages in the vessel. A stent maybe placed within the vessel to treat these blockages and intraluminalimaging may be carried out to view the placement of the stent within thevessel. Other types of treatment include thrombectomy, ablation,angioplasty, pharmaceuticals, etc.

In some embodiments, the automatic and assisted bookmarking systemincludes screen displays that provide a clinician with a suggested “nextbookmark” representing an upcoming region of interest, along withassociated label information, that the clinician or another user cansimply confirm when the desired intraluminal imaging frame from withinthe region of interest appears on the display.

When recording an IVUS pullback, the IVUS system successively stacks across-section of each recorded tomographic frame onscreen. The resultingimage stack is called the In Line Digital or Image Longitudinal Display(ILD) view. Bookmarks can be automatically associated with theintraluminal image itself, as well as the ILD and/or a roadmap orgraphical roadmap image, and reports generated therefrom.

IVUS pullback measurements results require recording, bookmarking,labeling, annotation, and reporting on the part of the clinician. Theautomatic and assisted bookmarking system eases the workload on theclinician, and permits certain aspects of bookmarking, labelingannotation and reporting to happen automatically during the IVUSprocedure itself.

These descriptions are provided for exemplary purposes only, and shouldnot be considered to limit the scope of the automatic and assistedbookmarking system. Certain features may be added, removed, or modifiedwithout departing from the spirit of the claimed subject matter.

For the purposes of promoting an understanding of the principles of thepresent disclosure, reference will now be made to the embodimentsillustrated in the drawings, and specific language will be used todescribe the same. It is nevertheless understood that no limitation tothe scope of the disclosure is intended. Any alterations and furthermodifications to the described devices, systems, and methods, and anyfurther application of the principles of the present disclosure arefully contemplated and included within the present disclosure as wouldnormally occur to one skilled in the art to which the disclosurerelates. In particular, it is fully contemplated that the features,components, and/or steps described with respect to one embodiment may becombined with the features, components, and/or steps described withrespect to other embodiments of the present disclosure. For the sake ofbrevity, however, the numerous iterations of these combinations will notbe described separately.

FIG. 1 is a diagrammatic schematic view of an intraluminal imagingsystem incorporating the automatic and assisted bookmarking system,according to aspects of the present disclosure. The intraluminal imagingsystem 100 can be an intravascular ultrasound (IVUS) imaging system insome embodiments. The intraluminal imaging system 100 may include anintraluminal device 102, a patient interface module (PIM) 104, a consoleor processing system 106, a monitor 108, and an external imaging system132 which may include angiography, ultrasound, X-ray, computedtomography (CT), magnetic resonance imaging (MRI), or other imagingtechnologies, equipment, and methods. The intraluminal device 102 issized and shaped, and/or otherwise structurally arranged to bepositioned within a body lumen of a patient. For example, theintraluminal device 102 can be a catheter, guide wire, guide catheter,pressure wire, and/or flow wire in various embodiments. In somecircumstances, the system 100 may include additional elements and/or maybe implemented without one or more of the elements illustrated inFIG. 1. For example, the system 100 may omit the external imaging system132.

The intraluminal imaging system 100 (or intravascular imaging system)can be any type of imaging system suitable for use in the lumens orvasculature of a patient. In some embodiments, the intraluminal imagingsystem 100 is an intraluminal ultrasound (IVUS) imaging system. In otherembodiments, the intraluminal imaging system 100 may include systemsconfigured for forward looking intraluminal ultrasound (FL-IVUS)imaging, intraluminal photoacoustic (IVPA) imaging, intracardiacechocardiography (ICE), transesophageal echocardiography (TEE), and/orother suitable imaging modalities.

It is understood that the system 100 and/or device 102 can be configuredto obtain any suitable intraluminal imaging data. In some embodiments,the device 102 may include an imaging component of any suitable imagingmodality, such as optical imaging, optical coherence tomography (OCT),etc. In some embodiments, the device 102 may include any suitablenon-imaging component, including a pressure sensor, a flow sensor, atemperature sensor, an optical fiber, a reflector, a mirror, a prism, anablation element, a radio frequency (RF) electrode, a conductor, orcombinations thereof. Generally, the device 102 can include an imagingelement to obtain intraluminal imaging data associated with the lumen120. The device 102 may be sized and shaped (and/or configured) forinsertion into a vessel or lumen 120 of the patient.

The system 100 may be deployed in a catheterization laboratory having acontrol room. The processing system 106 may be located in the controlroom. Optionally, the processing system 106 may be located elsewhere,such as in the catheterization laboratory itself. The catheterizationlaboratory may include a sterile field while its associated control roommay or may not be sterile depending on the procedure to be performedand/or on the health care facility. The catheterization laboratory andcontrol room may be used to perform any number of medical imagingprocedures such as angiography, fluoroscopy, CT, IVUS, virtual histology(VH), forward looking IVUS (FL-IVUS), intraluminal photoacoustic (IVPA)imaging, a fractional flow reserve (FFR) determination, a coronary flowreserve (CFR) determination, optical coherence tomography (OCT),computed tomography, intracardiac echocardiography (ICE),forward-looking ICE (FLICE), intraluminal palpography, transesophagealultrasound, fluoroscopy, and other medical imaging modalities, orcombinations thereof. In some embodiments, device 102 may be controlledfrom a remote location such as the control room, such than an operatoris not required to be in close proximity to the patient.

The intraluminal device 102, PIM 104, monitor 108, and external imagingsystem 132 may be communicatively coupled directly or indirectly to theprocessing system 106. These elements may be communicatively coupled tothe medical processing system 106 via a wired connection such as astandard copper link or a fiber optic link and/or via wirelessconnections using IEEE 802.11 Wi-Fi standards, Ultra Wide-Band (UWB)standards, wireless FireWire, wireless USB, or another high-speedwireless networking standard. The processing system 106 may becommunicatively coupled to one or more data networks, e.g., aTCP/IP-based local area network (LAN). In other embodiments, differentprotocols may be utilized such as Synchronous Optical Networking(SONET). In some cases, the processing system 106 may be communicativelycoupled to a wide area network (WAN). The processing system 106 mayutilize network connectivity to access various resources. For example,the processing system 106 may communicate with a Digital Imaging andCommunications in Medicine (DICOM) system, a Picture Archiving andCommunication System (PACS), and/or a Hospital Information System (HIS)via a network connection.

At a high level, an ultrasound imaging intraluminal device 102 emitsultrasonic energy from a transducer array 124 included in scannerassembly 110 mounted near a distal end of the intraluminal device 102.The ultrasonic energy is reflected by tissue structures in the medium(such as a lumen 120) surrounding the scanner assembly 110, and theultrasound echo signals are received by the transducer array 124. Thescanner assembly 110 generates electrical signal(s) representative ofthe ultrasound echoes. The scanner assembly 110 can include one or moresingle ultrasound transducers and/or a transducer array 124 in anysuitable configuration, such as a planar array, a curved array, acircumferential array, an annular array, etc. For example, the scannerassembly 110 can be a one-dimensional array or a two-dimensional arrayin some instances. In some instances, the scanner assembly 110 can be arotational ultrasound device. The active area of the scanner assembly110 can include one or more transducer materials and/or one or moresegments of ultrasound elements (e.g., one or more rows, one or morecolumns, and/or one or more orientations) that can be uniformly orindependently controlled and activated. The active area of the scannerassembly 110 can be patterned or structured in various basic or complexgeometries. The scanner assembly 110 can be disposed in a side-lookingorientation (e.g., ultrasonic energy emitted perpendicular and/ororthogonal to the longitudinal axis of the intraluminal device 102)and/or a forward-looking looking orientation (e.g., ultrasonic energyemitted parallel to and/or along the longitudinal axis). In someinstances, the scanner assembly 110 is structurally arranged to emitand/or receive ultrasonic energy at an oblique angle relative to thelongitudinal axis, in a proximal or distal direction. In someembodiments, ultrasonic energy emission can be electronically steered byselective triggering of one or more transducer elements of the scannerassembly 110.

The ultrasound transducer(s) of the scanner assembly 110 can be apiezoelectric micromachined ultrasound transducer (PMUT), capacitivemicromachined ultrasonic transducer (CMUT), single crystal, leadzirconate titanate (PZT), PZT composite, other suitable transducer type,and/or combinations thereof. In an embodiment the ultrasound transducerarray 124 can include any suitable number of individual transducerelements or acoustic elements between 1 acoustic element and 1000acoustic elements, including values such as 2 acoustic elements, 4acoustic elements, 36 acoustic elements, 64 acoustic elements, 128acoustic elements, 500 acoustic elements, 812 acoustic elements, and/orother values both larger and smaller.

The PIM 104 transfers the received echo signals to the processing system106 where the ultrasound image (including the flow information) isreconstructed and displayed on the monitor 108. The console orprocessing system 106 can include a processor and a memory. Theprocessing system 106 may be operable to facilitate the features of theintraluminal imaging system 100 described herein. For example, theprocessor can execute computer readable instructions stored on thenon-transitory tangible computer readable medium.

The PIM 104 facilitates communication of signals between the processingsystem 106 and the scanner assembly 110 included in the intraluminaldevice 102. This communication may include providing commands tointegrated circuit controller chip(s) within the intraluminal device102, selecting particular element(s) on the transducer array 124 to beused for transmit and receive, providing the transmit trigger signals tothe integrated circuit controller chip(s) to activate the transmittercircuitry to generate an electrical pulse to excite the selectedtransducer array element(s), and/or accepting amplified echo signalsreceived from the selected transducer array element(s) via amplifiersincluded on the integrated circuit controller chip(s). In someembodiments, the PIM 104 performs preliminary processing of the echodata prior to relaying the data to the processing system 106. Inexamples of such embodiments, the PIM 104 performs amplification,filtering, and/or aggregating of the data. In an embodiment, the PIM 104also supplies high- and low-voltage DC power to support operation of theintraluminal device 102 including circuitry within the scanner assembly110.

The processing system 106 receives echo data from the scanner assembly110 by way of the PIM 104 and processes the data to reconstruct an imageof the tissue structures in the medium surrounding the scanner assembly110. Generally, the device 102 can be utilized within any suitableanatomy and/or body lumen of the patient. The processing system 106outputs image data such that an image of the vessel or lumen 120, suchas a cross-sectional IVUS image of the lumen 120, is displayed on themonitor 108. Lumen 120 may represent fluid filled or fluid-surroundedstructures, both natural and man-made. Lumen 120 may be within a body ofa patient. Lumen 120 may be a blood vessel, such as an artery or a veinof a patient's vascular system, including cardiac vasculature,peripheral vasculature, neural vasculature, renal vasculature, and/or orany other suitable lumen inside the body. For example, the device 102may be used to examine any number of anatomical locations and tissuetypes, including without limitation, organs including the liver, heart,kidneys, gall bladder, pancreas, lungs; ducts; intestines; nervoussystem structures including the brain, dural sac, spinal cord andperipheral nerves; the urinary tract; as well as valves within theblood, chambers or other parts of the heart, and/or other systems of thebody. In addition to natural structures, the device 102 may be used toexamine man-made structures such as, but without limitation, heartvalves, stents, shunts, filters and other devices.

The controller or processing system 106 may include a processing circuithaving one or more processors in communication with memory and/or othersuitable tangible computer readable storage media. The controller orprocessing system 106 may be configured to carry out one or more aspectsof the present disclosure. In some embodiments, the processing system106 and the monitor 108 are separate components. In other embodiments,the processing system 106 and the monitor 108 are integrated in a singlecomponent. For example, the system 100 can include a touch screendevice, including a housing having a touch screen display and aprocessor. The system 100 can include any suitable input device, such asa touch sensitive pad or touch screen display, keyboard/mouse, joystick,button, etc., for a user to select options shown on the monitor 108. Theprocessing system 106, the monitor 108, the input device, and/orcombinations thereof can be referenced as a controller of the system100. The controller can be in communication with the device 102, the PIM104, the processing system 106, the monitor 108, the input device,and/or other components of the system 100.

In some embodiments, the intraluminal device 102 includes some featuressimilar to traditional solid-state IVUS catheters, such as the EagleEye®catheter available from Volcano Corporation and those disclosed in U.S.Pat. No. 7,846,101 hereby incorporated by reference in its entirety. Forexample, the intraluminal device 102 may include the scanner assembly110 near a distal end of the intraluminal device 102 and a transmissionline bundle 112 extending along the longitudinal body of theintraluminal device 102. The cable or transmission line bundle 112 caninclude a plurality of conductors, including one, two, three, four,five, six, seven, or more conductors.

The transmission line bundle 112 terminates in a PIM connector 114 at aproximal end of the intraluminal device 102. The PIM connector 114electrically couples the transmission line bundle 112 to the PIM 104 andphysically couples the intraluminal device 102 to the PIM 104. In anembodiment, the intraluminal device 102 further includes a guidewireexit port 116. Accordingly, in some instances the intraluminal device102 is a rapid-exchange catheter. The guidewire exit port 116 allows aguidewire 118 to be inserted towards the distal end in order to directthe intraluminal device 102 through the lumen 120.

The monitor 108 may be a display device such as a computer monitor orother type of screen. The monitor 108 may be used to display selectableprompts, instructions, and visualizations of imaging data to a user. Insome embodiments, the monitor 108 may be used to provide aprocedure-specific workflow to a user to complete an intraluminalimaging procedure. This workflow may include performing a pre-stent planto determine the state of a lumen and potential for a stent, as well asa post-stent inspection to determine the status of a stent that has beenpositioned in a lumen. The workflow may be presented to a user as any ofthe displays or visualizations shown in FIGS. 5-11.

The external imaging system 132 can be configured to obtain x-ray,radiographic, angiographic/venographic (e.g., with contrast), and/orfluoroscopic (e.g., without contrast) images of the body of a patient(including the vessel 120). External imaging system 132 may also beconfigured to obtain computed tomography images of the body of thepatient (including the vessel 120). The external imaging system 132 mayinclude an external ultrasound probe configured to obtain ultrasoundimages of the body of the patient (including the vessel 120) whilepositioned outside the body. In some embodiments, the system 100includes other imaging modality systems (e.g., MRI) to obtain images ofthe body of the patient (including the vessel 120). The processingsystem 106 can utilize the images of the body of the patient inconjunction with the intraluminal images obtained by the intraluminaldevice 102.

FIG. 2 illustrates blood vessels (e.g., arteries and veins) in the humanbody. For example, veins of the human body are labeled. Aspects of thepresent disclosure can be related to peripheral vasculature, e.g., veinsin the torso or legs.

Occlusions can occur in arteries or veins. An occlusion can be generallyrepresentative of any blockage or other structural arrangement thatresults in a restriction to the flow of fluid through the lumen (e.g.,an artery or a vein), for example, in a manner that is deleterious tothe health of the patient. For example, the occlusion narrows the lumensuch that the cross-sectional area of the lumen and/or the availablespace for fluid to flow through the lumen is decreased. Where theanatomy is a blood vessel, the occlusion may be a result of narrowingdue to compression (e.g. from external vessels), plaque buildup,including without limitation plaque components such as fibrous,fibro-lipidic (fibro fatty), necrotic core, calcified (dense calcium),blood, and/or different stages of thrombus (e.g., acute, sub-acute,chronic, etc.). In some instances, the occlusion can be referenced asthrombus, a stenosis, and/or a lesion. Generally, the composition of theocclusion will depend on the type of anatomy being evaluated. Healthierportions of the anatomy may have a uniform or symmetrical profile (e.g.,a cylindrical profile with a circular cross-sectional profile). Theocclusion may not have a uniform or symmetrical profile. Accordingly,diseased or compressed portions of the anatomy, with the occlusion, willhave a non-symmetric and/or otherwise irregular profile. The anatomy canhave one occlusion or multiple occlusions.

Build-up of occlusion (e.g., thrombus, deep vein thrombosis or DVT,chronic total occlusion or CTO, etc.) is one way in which thecross-sectional area of the vein in the peripheral vasculature (e.g.,torso, abdomen, groin, leg) may be reduced. Other anatomy that contactsthe vein can also reduce its cross-sectional area, thereby restrictingblood flow therethrough. For example, arteries or ligaments in thetorso, abdomen, groin, or leg can press against a vein, which changesthe shape of the vein and reduces its cross-sectional area. Suchreductions in cross-sectional area resulting from contact with otheranatomy can be referenced as compression, in that the walls of the veinare compressed as a result of the contact with the artery or ligament.

FIG. 3 illustrates a blood vessel 300 incorporating a compression 330.The compression 330 occurs outside the vessel walls 310 and may restrictthe flow of blood 320. The compression may be caused by other anatomicalstructures outside the blood vessel 300, including but not limited to atendon, ligament, or neighboring lumen.

FIG. 4 illustrates a blood vessel 300 incorporating a compression 330and with a stent 440 expanded inside it to restore flow. The stent 440displaces and arrests the compression 330, pushing the vessel walls 310outward, thus reducing the flow restriction for the blood 320. Othertreatment options for alleviating an occlusion may include but are notlimited to thrombectomy, ablation, angioplasty, and pharmaceuticals.However, in a large majority of cases it may be highly desirable toobtain accurate and timely intravascular images of the affected area,along with accurate and detailed knowledge of the location, orientation,length, and volume of the affected area prior to, during, or aftertreatment.

FIG. 5 illustrates an example intraluminal imaging display screen 500 inaccordance with at least one embodiment of the present disclosure. Inthis example, the screen display 500 includes a current tomographic IVUSimage 510 from a series of successive tomographic images, an ImageLongitudinal Display (ILD) 520 containing stacked longitudinalcross-sections of the series of successive tomographic images, and agraphical roadmap 530. Also visible are bookmarks 540 a, 540 b, 540 c,540 d, 540 e, and 540 f, that are associated with both the graphicalroadmap 530 and the ILD 520. Bookmark 540 d is also associated with thecurrent IVUS image 510, as is a label 550 that contains informationabout the location and nature of the IVUS image 510. In this example,the IVUS image is identified as a reference image of the left externaliliac vein. In addition, the bookmark information can be saved toreports that are automatically generated. If a change to the bookmark ismade in any of these locations, the automatic and assisted bookmarkingsystem updates the bookmark in all of these locations, thus saving timeand simplifying the bookmark editing workflow.

FIG. 6 shows a graphical roadmap screen display 530 of an exemplaryautomatic and assisted bookmarking system during a pullback procedure ina left leg vein of a patient, in accordance with at least one embodimentof the present disclosure. In this example, the graphical roadmap screendisplay includes multiple vein segments: the inferior vena cava (IVC)610, the left common iliac vein (CIV) 620, the left external iliac vein(EIV) 630, left common femoral vein (CFV) 640, and a left femoral vein(F) 650. The corresponding segments on the right side 660 are also shownfor reference, but are grayed out to indicate they are not part of thecurrent procedure and will not be traversed by the intraluminal imagingprobe during the procedure. Other vessel segments or lumen segments maybe identified in other areas of the body. In some embodiments, theidentification of vessel segments is performed automatically by theautomatic and assisted bookmarking system (e.g., using imagerecognition, speed tracking, and position estimation), and bookmarks areautomatically applied. In other embodiments, bookmarks are predictivelysuggested to the clinician or other user. Predicting the next bookmarkthat the user will need advantageously avoids a requirement for the userto look through a list of bookmarks to find the correct one, or type ina manual bookmark. In other embodiments, the identification of vesselsegments is performed by a clinician or other user with the assistanceof the automatic and assisted bookmarking system. Bookmarks or labelscan be applied for example to a location where the segment begins orends, or another segment begins or ends.

In the example shown in FIG. 6, the automatic and assisted bookmarkingsystem is offering the clinician or other user an instruction 670 and abookmark 680 that are based on the system's knowledge of the procedurebeing performed, the current location and movement direction of theintraluminal imaging probe 102 within the lumen 300, the proximity ofanatomical landmarks (e.g., branches of the lumen or of neighboringlumens), and other information as necessary to perform the function.When the clinician or other user has advanced the intraluminal imagingprobe 102 into the portion of the lumen 300 indicated by the instruction670, the clinician or other user then activates or confirms thebookmark, e.g., by double-clicking on it, or by dragging and dropping itonto the current intraluminal image 510 in the intraluminal imagingdisplay screen 500, or by issuing a vocal command to confirm thebookmark for the current intraluminal image 510. When this is done, thebookmark 680 is automatically associated not only with the currentintraluminal image 510, but with the corresponding locations on the ILD520 and graphical roadmap 530. In addition, the automatic and assistedbookmarking system automatically populates a label 550 that isautomatically associated with the bookmark 680 and the currentintraluminal image and may include, for example, the bookmarkinformation, image location, and image type (e.g., reference,pre-treatment target, post-treatment target, etc.) In some embodiments,these steps are performed automatically by the automatic and assistedbookmarking system, without the need for user input of any kind, basedon image recognition to track known bifurcations of a vessel or lumen asanatomic landmarks. Bookmarks may also be suggested or automaticallyplaced based on automated image recognition of issues such as thrombus,webbing, and compression (venous) or stenosis (arterial).

Examples of border detection, image processing, image analysis, and/orpattern recognition include U.S. Pat. No. 6,200,268 entitled “VASCULARPLAQUE CHARACTERIZATION” issued Mar. 13, 2001 with D. Geoffrey Vince,Barry D. Kuban and Anuja Nair as inventors, U.S. Pat. No. 6,381,350entitled “INTRAVASCULAR ULTRASONIC ANALYSIS USING ACTIVE CONTOUR METHODAND SYSTEM” issued Apr. 30, 2002 with Jon D. Klingensmith, D. GeoffreyVince and Raj Shekhar as inventors, U.S. Pat. No. 7,074,188 entitled“SYSTEM AND METHOD OF CHARACTERIZING VASCULAR TISSUE” issued Jul. 11,2006 with Anuja Nair, D. Geoffrey Vince, Jon D. Klingensmith and BarryD. Kuban as inventors, U.S. Pat. No. 7,175,597 entitled “NON-INVASIVETISSUE CHARACTERIZATION SYSTEM AND METHOD” issued Feb. 13, 2007 with D.Geoffrey Vince, Anuja Nair and Jon D. Klingensmith as inventors, U.S.Pat. No. 7,215,802 entitled “SYSTEM AND METHOD FOR VASCULAR BORDERDETECTION” issued May 8, 2007 with Jon D. Klingensmith, Anuja Nair,Barry D. Kuban and D. Geoffrey Vince as inventors, U.S. Pat. No.7,359,554 entitled “SYSTEM AND METHOD FOR IDENTIFYING A VASCULAR BORDER”issued Apr. 15, 2008 with Jon D. Klingensmith, D. Geoffrey Vince, AnujaNair and Barry D. Kuban as inventors and U.S. Pat. No. 7,463,759entitled “SYSTEM AND METHOD FOR VASCULAR BORDER DETECTION” issued Dec.9, 2008 with Jon D. Klingensmith, Anuja Nair, Barry D. Kuban and D.Geoffrey Vince, as inventors, the teachings of which are herebyincorporated by reference herein in their entirety.

FIG. 7 shows a graphical roadmap screen display 530 of an exemplaryautomatic and assisted bookmarking system during a pullback procedure ina left leg vein of a patient, in accordance with at least one embodimentof the present disclosure. As with the example of FIG. 6, the graphicalroadmap screen display includes multiple vein segments 610, 620, 630,640, and 650. The corresponding segments on the right side 660 are alsoshown for reference, but are grayed out. In this example, the screendisplay also includes a tomographic image 510. In this example, ratherthan offering a single instruction 670 and suggesting a single bookmark680, the automatic and assisted bookmarking system offers a menu 670that includes multiple different suggested markers (e.g., bookmarks) 680that are based the system's knowledge of the procedure being undertakenand direction of probe movement, along with an approximate but imperfectknowledge of the location of the intraluminal imaging probe 102 withinthe lumen 300. In this example, the system also offers an “Other” option780 that permits the clinician or other user to enter marker information(e.g., bookmark and label information) manually. This may be useful forexample during nonstandard procedures, or during procedures where thepositioning information for the intraluminal probe 102 is believed to beinaccurate. Inputs from the user allow the system to select a desiredbookmark from among the suggested bookmarks 680 and 780. In an example,the bookmark can be dragged and dropped onto either the tomographicimage 510 or the roadmap image 530, and it will automatically be appliedto both at the location corresponding to the currently displayedtomographic image.

In an example, a bookmark is a location marker on a pullback (e.g., onan ILD, roadmap, or cross-sectional tomographic image) that facilitateseasy navigation. A label is a text annotation that can be associatedwith a region in a frame or a pullback, or even a bookmark. A bookmarkcan look like a little flag, or mark in a longitudinal view or roadmap.A label may comprise text that may or may not be associated with abookmark.

FIG. 8 is a flow diagram 800 for an intraluminal image bookmarkingmethod according to the related art. In step 810, a primary user (e.g.,a clinician) pushes or pulls the intraluminal imaging probe 102 througha region of interest within the lumen 300. The region of interest mayfor example be a target region where diseased or compressed tissue is tobe inspected, or a reference region where the dimensions of the lumen300 may be recorded for comparison purposes.

In step 820, the primary user calls for a bookmark to label the currentintraluminal imaging frame. However, in general the primary user doesnot stop moving the intraluminal imaging probe 102, but continuespushing or pulling it at a near-constant speed.

Step 830 represents an inevitable time delay between the primary usercalling for a bookmark and a secondary user (e.g., a surgical assistantor non-sterile staff member) actually entering the bookmark information.This time delay is represented by the variable T1.

In step 840, the secondary user enters the bookmark information. Thismay involve typing in the current or suspected location of theintraluminal imaging probe 102, along with information about the type ofimage (e.g., target or reference). This data entry also takes time,represented by the variable T2. Meanwhile, in a typical intraluminalimaging procedure, the intraluminal imaging probe 102 continues movingat a relatively constant speed.

Once the imaging procedure (e.g., an IVUS pullback procedure) has beencompleted, in step 850 the primary user reviews the intraluminal imagingdata in a review mode of the intraluminal imaging system 100, andlocates the bookmark 540 that was placed by the secondary user. Veryfrequently, because of time delays T1 and T2, the bookmark has beenplaced on a later frame than the intended frame. In some instances, thebookmark may be placed on an earlier than intended frame if thesecondary user has anticipated and attempted to compensate for the timedelays T1 and T2.

In step 860, the primary user pages through the intraluminal images 510and/or the ILD 520 to find the image 510 where the bookmark 540 wasintended to be placed.

In step 870, the primary user relocates the bookmark 540 to the desiredimage 510, or deletes and re-enters the bookmark 540. The primary userthen performs measurements, annotations, and other analysis of thebookmarked image 510.

This process is time consuming and error prone, creating a need in theart for improved tools and procedures.

FIG. 9 is a is a flow diagram for an intraluminal image bookmarkingmethod 900 according to at least one embodiment of the presentdisclosure. In step 910, the primary user (e.g., a clinician) pushes orpulls the intraluminal imaging probe 102 through a region of interestwithin the lumen 300. The region of interest may for example be a targetregion or a reference region.

In step 920 the automatic and assisted bookmarking method 900 suggests abookmark 680 and/or associated label information 550 to the primaryuser. Based on the system's knowledge of the procedure type beingperformed, the point of entry, the direction of movement of theintraluminal imaging probe, and the location of the intraluminal imagingprobe, the system is able to anticipate what bookmarks will be needed,and in what order. In an example, the user may for example specifyjugular entry or femoral entry, and the direction of movement (e.g.,pullback or forward longitudinal movement). A typical procedure mightfor example involve pullback from either the abdomen to the leg or fromthe leg to the abdomen. The system knows the order and reverse order inwhich vessel segments occur (Hy, CIV, etc.) and presents them in thecorrect order based on the entry point and direction of movement.

In step 930, a user (either the primary user or a secondary user)confirms the bookmark and/or associated label information. Thisconfirmation may be performed for example by dragging and dropping thebookmark 680 onto the current intraluminal image 510, or bydouble-clicking on the bookmark 680, or by issuing a spoken confirmationto a voice recognition interface of the automatic and assistedbookmarking system (e.g., the processor circuit is receiving anelectrical signal representative of the spoken confirmation). Thus, thebookmark 680 is placed directly onto the desired frame during thepullback procedure, and requires no rework during a review stage.

In step 940, the primary user continues moving the intraluminal imagingprobe 102 at a constant speed through the lumen. In some instances, thesystem may return to step 920 and suggest additional bookmarks duringthe procedure. In other instances, the process is complete after step940.

Another aspect of the automatic and assisted bookmarking system is topresent the user with multiple neighboring frames around the bookmarkedframe. In the workflow illustrated in FIG. 8, the primary user doesn'tusually get the bookmark placed at the right frame because of the timedelay associated with T1 and perhaps T2. Some embodiments of the presentdisclosure assist the user by recording a set of frames or a short videoclip around the bookmark that allows the user to have more confidencethat the frame of interest is actually captured by the bookmark. Theuser can then select the actual frame during case review withoutaccessing the main pullback itself for reporting or studying in thecurrent case. Further, if the bookmark is edited in any of these frames,the change will be applied to all of them (and may also be applied toILD or roadmap images), thus simplifying the bookmark editing workflow.

FIG. 10 is a schematic diagram of a processor circuit 1050, according toembodiments of the present disclosure. The processor circuit 1050 may beimplemented in the ultrasound imaging system 100, or other devices orworkstations (e.g., third-party workstations, network routers, etc.), oron a cloud processor or other remote processing unit, as necessary toimplement the method. As shown, the processor circuit 1050 may include aprocessor 1060, a memory 1064, and a communication module 1068. Theseelements may be in direct or indirect communication with each other, forexample via one or more buses.

The processor 1060 may include a central processing unit (CPU), adigital signal processor (DSP), an ASIC, a controller, or anycombination of general-purpose computing devices, reduced instructionset computing (RISC) devices, application-specific integrated circuits(ASICs), field programmable gate arrays (FPGAs), or other related logicdevices, including mechanical and quantum computers. The processor 1060may also comprise another hardware device, a firmware device, or anycombination thereof configured to perform the operations describedherein. The processor 1060 may also be implemented as a combination ofcomputing devices, e.g., a combination of a DSP and a microprocessor, aplurality of microprocessors, one or more microprocessors in conjunctionwith a DSP core, or any other such configuration.

The memory 1064 may include a cache memory (e.g., a cache memory of theprocessor 1060), random access memory (RAM), magnetoresistive RAM(MRAM), read-only memory (ROM), programmable read-only memory (PROM),erasable programmable read only memory (EPROM), electrically erasableprogrammable read only memory (EEPROM), flash memory, solid state memorydevice, hard disk drives, other forms of volatile and non-volatilememory, or a combination of different types of memory. In an embodiment,the memory 1064 includes a non-transitory computer-readable medium. Thememory 1064 may store instructions 1066. The instructions 1066 mayinclude instructions that, when executed by the processor 1060, causethe processor 1060 to perform the operations described herein.Instructions 1066 may also be referred to as code. The terms“instructions” and “code” should be interpreted broadly to include anytype of computer-readable statement(s). For example, the terms“instructions” and “code” may refer to one or more programs, routines,sub-routines, functions, procedures, etc. “Instructions” and “code” mayinclude a single computer-readable statement or many computer-readablestatements.

The communication module 1068 can include any electronic circuitryand/or logic circuitry to facilitate direct or indirect communication ofdata between the processor circuit 1050, and other processors ordevices. In that regard, the communication module 1068 can be aninput/output (I/O) device. In some instances, the communication module1068 facilitates direct or indirect communication between variouselements of the processor circuit 1050 and/or the ultrasound imagingsystem 100. The communication module 1068 may communicate within theprocessor circuit 1050 through numerous methods or protocols. Serialcommunication protocols may include but are not limited to US SPI, I²C,RS-232, RS-485, CAN, Ethernet, ARINC 429, MODBUS, MIL-STD-1553, or anyother suitable method or protocol. Parallel protocols include but arenot limited to ISA, ATA, SCSI, PCI, IEEE-488, IEEE-1284, and othersuitable protocols. Where appropriate, serial and parallelcommunications may be bridged by a UART, USART, or other appropriatesubsystem.

External communication (including but not limited to software updates,firmware updates, preset sharing between the processor and centralserver, or readings from the ultrasound device) may be accomplishedusing any suitable wireless or wired communication technology, such as acable interface such as a USB, micro USB, Lightning, or FireWireinterface, Bluetooth, Wi-Fi, ZigBee, Li-Fi, or cellular data connectionssuch as 2G/GSM, 3G/UMTS, 4G/LTE/WiMax, or 5G. For example, a BluetoothLow Energy (BLE) radio can be used to establish connectivity with acloud service, for transmission of data, and for receipt of softwarepatches. The controller may be configured to communicate with a remoteserver, or a local device such as a laptop, tablet, or handheld device,or may include a display capable of showing status variables and otherinformation. Information may also be transferred on physical media suchas a USB flash drive or memory stick.

FIG. 11 is a screenshot of an IVUS access point selection screen 1100,in accordance with at least one embodiment of the present disclosure.The automatic and assisted bookmarking system may be generally capableof automatically identifying different regions of a patient'scirculatory system by using a machine-learning algorithm or othertraining-based AI algorithm to match IVUS images against an a prioridataset or knowledge set of statistically representative lumen anatomyfor different human subpopulations. However, the accuracy of vesselidentification is improved when the IVUS pullback venogram system beginswith accurate and specific information about the starting point anddirection of travel of the ultrasound transducer 124 of the imagingcatheter 102. In this example, the screen display 1100 thereforeincludes an access point selector 1110 that permits a clinician or otheruser to select between femoral access and jugular access. The screendisplay 1100 also includes a target limb selector 1120 that permits aclinician or other user to select between a patient's right leg and leftleg as the location of the IVUS pullback. These examples are merelyillustrative; other access points and target limbs, target regions(e.g., the abdomen), or target anatomy (e.g., the heart) are alsopossible and may be used instead or in addition, depending on theprocedure type, disease type, and location of the anatomical features ofinterest.

Also visible are an exit button 1130 and a start button 1140. Othercontrols may also be provided including but not limited to help buttons,procedure type selectors, disease type selectors, and anatomy typeselectors.

A number of variations are possible on the examples and embodimentsdescribed above. For example, the automatic and assisted bookmarkingsystem may be employed in anatomical systems within the body other thanthose described, or may be employed to image other disease types, objecttypes, or procedure types than those described. The technology describedherein may be applied to intraluminal imaging sensors of diverse types,whether currently in existence or hereinafter developed. The system maybe employed with IVUS for coronary arterial and peripheral use inarterial or venous imaging, such as Philips' IGT-D devices and IVUSconsole software. Alternatively or in addition, the system may beemployed with X-ray, angiogram, and venogram applications that requireor enable labels and bookmarks. The system may be employed with anyimaging modality that employs labels or bookmarks, but with allowedediting of those findings.

Accordingly, the logical operations making up the embodiments of thetechnology described herein are referred to variously as operations,steps, objects, elements, components, or modules. Furthermore, it shouldbe understood that these may occur or be performed in any order, unlessexplicitly claimed otherwise or a specific order is inherentlynecessitated by the claim language. All directional references e.g.,upper, lower, inner, outer, upward, downward, left, right, lateral,front, back, top, bottom, above, below, vertical, horizontal, clockwise,counterclockwise, proximal, and distal are only used for identificationpurposes to aid the reader's understanding of the claimed subjectmatter, and do not create limitations, particularly as to the position,orientation, or use of the automatic and assisted bookmarking system.Connection references, e.g., attached, coupled, connected, and joinedare to be construed broadly and may include intermediate members betweena collection of elements and relative movement between elements unlessotherwise indicated. As such, connection references do not necessarilyimply that two elements are directly connected and in fixed relation toeach other. The term “or” shall be interpreted to mean “and/or” ratherthan “exclusive or.” Unless otherwise noted in the claims, stated valuesshall be interpreted as illustrative only and shall not be taken to belimiting.

The above specification, examples and data provide a completedescription of the structure and use of exemplary embodiments of theautomatic and assisted bookmarking system as defined in the claims.Although various embodiments of the claimed subject matter have beendescribed above with a certain degree of particularity, or withreference to one or more individual embodiments, those skilled in theart could make numerous alterations to the disclosed embodiments withoutdeparting from the spirit or scope of the claimed subject matter. Stillother embodiments are contemplated. It is intended that all mattercontained in the above description and shown in the accompanyingdrawings shall be interpreted as illustrative only of particularembodiments and not limiting. Changes in detail or structure may be madewithout departing from the basic elements of the subject matter asdefined in the following claims.

What is claimed is:
 1. An intraluminal ultrasound imaging system,comprising: a processor circuit configured for communication with anintraluminal ultrasound imaging catheter, wherein the processor circuitis configured to: receive a plurality of intraluminal ultrasound imagesobtained by the intraluminal ultrasound imaging catheter during movementof the intraluminal ultrasound imaging catheter within a body lumen of apatient, the body lumen comprising a plurality of segments; generate amarker to be applied to an intraluminal ultrasound image of theplurality of intraluminal ultrasound images, wherein the marker isgenerated based on the movement of the intraluminal ultrasound imagingcatheter, and wherein the marker is representative of a segment of theplurality of segments; and output, to a display in communication withthe processor circuit, a screen display comprising the marker and theplurality of intraluminal ultrasound images.
 2. The system of claim 1,further comprising a user interface, wherein the processor circuit isconfigured to receive a user input, via the user interface, to apply themarker to the intraluminal ultrasound image of the plurality ofintraluminal ultrasound images.
 3. The system of claim 2, wherein, inresponse to the receiving the user input to apply the marker, theprocessor circuit is configured to apply with the marker one or moreother intraluminal ultrasound images neighboring the intraluminalultrasound image.
 4. The system of claim 2, wherein the displaycomprises a touchscreen, and wherein the user interface comprises adrag-and-drop interface on the touchscreen, and wherein the user inputcomprises a drag-and-drop input.
 5. The system of claim 2, wherein theuser interface comprises a voice recognition interface, and the userinput comprises a spoken confirmation.
 6. The system of claim 1, whereinthe processor circuit is further configured to output stylized diagramof the body lumen comprising the plurality of segments, wherein themarker identifies a location in the stylized diagram where the segmentbegins.
 7. The system of claim 1, wherein the processor circuit isconfigured to: generate a plurality of markers to be applied to theplurality of ultrasound images; and output the plurality of markerssuccessively, wherein each of the plurality of markers corresponds to adifferent segment of the plurality of segments.
 8. The system of claim7, wherein the processor circuit is configured to determine an order forthe successive output of the plurality of markers based on the movementof the intraluminal ultrasound imaging catheter.
 9. The system of claim8, wherein the processor circuit is configured to determine the orderbased on at least one of an access point to the body lumen or adirection of movement of the intraluminal ultrasound imaging catheter.10. The system of claim 1, further comprising the intraluminalultrasound imaging catheter, wherein the intraluminal ultrasound imagingcatheter comprises an intravascular ultrasound (IVUS) imaging catheter,and wherein the body lumen comprises a peripheral blood vessel.
 11. Anintraluminal ultrasound imaging system, comprising: a processor circuitconfigured for communication with an intraluminal ultrasound imagingcatheter, wherein the processor circuit is configured to: receive anintraluminal ultrasound image obtained by the intraluminal ultrasoundimaging catheter during movement of the intraluminal ultrasound imagingcatheter within a body lumen of a patient; generate a plurality of textlabels; output a screen display comprising a first portion comprises theintraluminal ultrasound image and a second portion comprising theplurality of text labels, wherein the first portion is proximate to thesecond portion; receive a drag-and-drop user input moving a text labelof the plurality of text labels from the second portion to the firstportion; and associate the text label with the intraluminal ultrasoundimage.
 12. An intraluminal ultrasound imaging method, comprising:receiving, at a processor circuit in communication with an intraluminalultrasound imaging catheter, a plurality of intraluminal ultrasoundimages obtained by the intraluminal ultrasound imaging catheter duringmovement of the intraluminal ultrasound imaging catheter within a bodylumen of a patient, the body lumen comprising a plurality of segments;generating a marker to be applied to an intraluminal ultrasound image ofthe plurality intraluminal ultrasound images, wherein the marker isgenerated based on the movement of the intraluminal ultrasound imagingcatheter, and wherein the marker is representative of a segment of theplurality of segments; and outputting, to a display in communicationwith the processor circuit, a screen display comprising the marker andthe plurality of intraluminal ultrasound images shown successively. 13.The method of claim 12, further comprising receiving a user input, via auser interface operating on the processor circuit, to apply the markerto the intraluminal ultrasound image of the plurality of intraluminalultrasound images.
 14. The method of claim 13, further comprising, inresponse to the receiving the user input to apply the marker, applyingthe marker to one or more other intraluminal ultrasound imagesneighboring the intraluminal ultrasound image.
 15. The method of claim13, wherein the display comprises a touchscreen, and wherein the userinterface comprises a drag-and-drop interface on the touchscreen, andwherein the user input comprises a drag-and-drop input.
 16. The methodof claim 13, wherein the user interface comprises a voice recognitioninterface, and the user input comprises a spoken confirmation.
 17. Themethod of claim 12, further comprising outputting a stylized diagram ofthe body lumen comprising the plurality of segments, wherein the markeridentifies a location in the stylized diagram where the segment begins.18. The method of claim 12, further comprising: generating a pluralityof markers to be applied to o; and outputting, to the display incommunication with the processor circuit, a screen display comprisingthe plurality of markers successively, wherein each of the plurality ofmarkers corresponds to a different segment of the plurality of segments.19. The method of claim 18, further comprising determining an order forthe successive output of the plurality of markers based on the movementof the intraluminal ultrasound imaging catheter.
 20. The method of claim19, further comprising determining the order based on at least one of anaccess point to the body lumen or a direction of movement of theintraluminal ultrasound imaging catheter.